Emergency Scenario 470_f1

Location Information

Full Location:

Hafnargata 14, 470 Bíldudalur. Two-story wooden house, built in 1955. Main entrance faces the street. No elevator, only a central staircase. Street parking available. No security features. Current conditions: 8°C, overcast, good visibility. GPS coordinates: 65.6883° N, 23.5338° W. Nearest landmark: Bíldudalur harbor.

Municipality: Bíldudalur

Postal Code: 470

Emergency Details

Type: Stroke Symptoms

Priority Level: F1

Response Time Goal: Immediate (0-15 minutes)

Description:

72-year-old male, sudden onset of stroke symptoms. Primary symptoms: Right-sided facial droop, right arm weakness, slurred speech. Patient is conscious but confused. Secondary symptoms: Mild headache, dizziness. Patient is sitting in a chair in his living room. Medical history: Hypertension, type 2 diabetes, atrial fibrillation. Medications: Metoprolol 50mg daily, Metformin 500mg twice daily, Warfarin 5mg daily. No known allergies. Last meal was a light lunch at 12:00.

History of Events

Timeline:
1315 hours: Patient was watching TV and suddenly started slurring his speech and complained of feeling dizzy.
1316 hours: Patient's right arm became weak, and his face started to droop on the right side.
1317 hours: Patient's wife, Guðrún, noticed the symptoms and immediately called emergency services.
1318 hours: Current time, patient is conscious but confused, sitting in a chair in the living room.

Prior Events: Patient has a history of hypertension and atrial fibrillation. He had a minor stroke two years ago with full recovery. Last medical check-up was six months ago, routine follow-up. No recent illnesses or injuries. Patient lives with his wife, who is the caller.

Diagnostics

Initial Assessment

Initial Impression: Suspected Acute Stroke (CVA)
Justification for F1 Classification:
- Sudden onset of focal neurological deficits (facial droop, arm weakness, slurred speech)
- High probability of acute stroke, a time-critical condition requiring immediate intervention
- Patient's medical history (hypertension, atrial fibrillation) increases stroke risk
- Confusion and altered mental status indicate significant neurological compromise

Differential Diagnoses:
1. Ischemic Stroke (most likely given symptoms and risk factors)
2. Hemorrhagic Stroke (possible, requires CT scan to rule out)
3. Transient Ischemic Attack (TIA) (less likely given persistent symptoms)
4. Hypoglycemia (possible, but less likely given diabetes management)

Required Actions:
- Immediate dispatch of ground EMS with ALS capabilities
- Pre-notification of the nearest stroke center (Ísafjörður Hospital)
- Assessment of stroke severity using a standardized stroke scale (e.g., NIHSS)
- Initiation of stroke protocols including rapid transport and potential thrombolytic therapy

Final Diagnosis

Final Diagnosis: Acute Ischemic Stroke
Key Findings:
- CT scan of the brain revealed a large ischemic stroke in the left middle cerebral artery territory.
- Patient's NIHSS score was 12, indicating a moderate to severe stroke.
- Blood glucose was within normal range, ruling out hypoglycemia.
- No evidence of intracranial hemorrhage on CT scan.

Outcome validated F1 priority assignment. Rapid dispatch and pre-notification were crucial for timely intervention. Patient received intravenous thrombolysis within 3 hours of symptom onset. Patient was admitted to the stroke unit for ongoing care.

Learning Points:
1. F1 classification was appropriate given the time-critical nature of acute stroke.
2. Initial assessment accurately identified the high likelihood of stroke based on presenting symptoms.
3. Rapid dispatch, pre-notification, and timely thrombolysis significantly improved patient outcome.

Emergency Call Transcript

Dispatcher Emergency services, what's your emergency?

Caller My husband, I think he's having a stroke! He's acting strange.

Dispatcher Okay, I'm sending help. What is your address?

Caller It's Hafnargata 14 in Bíldudalur.

Dispatcher Help is on its way. Can you tell me what happened?

Caller He was watching TV and suddenly started slurring his words and seems confused. His right arm is weak, and his face is drooping on one side.

Dispatcher Is he awake and talking to you?

Caller Yes, he is awake but he is confused. He can't speak properly.

Dispatcher Does he have any medical conditions?

Caller Yes, he has high blood pressure, diabetes and atrial fibrillation. He takes medication for it.

Dispatcher Okay, the ambulance is on its way. Do not give him anything to eat or drink. Stay with him and keep him calm.

Caller Okay, thank you. I will wait here with him.